THE FOLLOWING IS FROM NEW YORK
TIMES BESTSELLER BOOK, THE COMING PLAGUE, NEWLY EMERGING DISEASES IN A WORLD
OUT OF BALANCE, BY LAURIE GARRETT, PULITZER PRIZE WINNING REPORTER AND
AUTHOR OF BETRAYAL OF TRUST, COPYRIGHT 1994

". . . .AMID THE NEAR-FANATIC
ENTHUSIASM FOR ANTIBIOTICS THERE WERE REPORTS, FROM THE FIRST DAYS OF THEIR
CLINICAL USE, OF THE EXISTENCE OF BACTERIA THAT WERE RESISTANT TO THE CHEMICALS.
DOCTORS SOON SAW PATIENTS WHO COULDN'T BE HEALED, AND LABORATORY SCIENTISTS WERE
ABLE TO FILL PETRI DISHES TO THE BRIM WITH VAST COLONIES OF STAPHYLOCOCCUS OR STREPTOCOCCUS
THAT THRIVED IN SOLUTIONS RICH IN PENICILLIN, TETRACYCLINE, OR ANY
OTHER ANTIBIOTIC THEY CHOSE TO STUDY.

IN 1952 A YOUNG UNIVERSITY OF
WISCONSIN MICROBIOLOGIST NAMED JOSHUA LEDERBERG AND HIS WIFE, ESTER, PROVED THAT
THESE BACTERIA'S ABILITY TO OUTWIT ANTIBIOTICS WAS DUE TO SPECIAL
CHARACTERISTICS FOUND IN THEIR DNA. SOME BACTERIA, THEY CONCLUDED, WERE
GENETICALLY RESISTANT TO PENICILLIN OR OTHER DRUGS, AND HAD POSED THAT TRAIT
FOR EONS; CERTAINLY BEFORE HOMOSAPIENS DISCOVERED ANTIBIOTICS. (14) IN YEARS TO
COME, THE LEDERBERGS' HYPOTHESIS THAT RESISTANCE TO ANTIBIOTICS WAS INHERENT IN
SOME BACTERIAL SPECIES WOULD PROVE TO BE TRUE.

THE LEDERBERGS HAD STUMBLED INTO
THE WORLD OF BACTERIAL EVOLUTION. IF MILLIONS OF BACTERIA MUST COMPETE
AMONG ONE ANOTHER IN ENDLESS TURF BATTLES, JOCKEYING FOR POSITION INSIDE THE
HUMAN GUT OR ON THE WARM, MOIST SKIN OF AN ARMPIT, IT MADE SENSE THAT THEY WOULD
HAVE EVOLVED CHEMICAL WEAPONS WITH WHICH TO WIPE OUT COMPETITORS.
FURTHERMORE, YEAST - THE MOLDS AND SOIL ORGANISMS THAT WERE THE NATURAL SOURCES
OF THE WORLD'S THEN BURGEONING ANTIBIOTIC PHARMACEUTICS - HAD EVOLVED THE
ABILITY TO MANUFACTURE THE SAME CHEMICALS FOR SIMILAR ECOLOGICAL REASONS.

IT STOOD TO REASON THAT
POPULATIONS OF ORGANISMS COULD SURVIVE ONLY IF SOME INDIVIDUAL MEMBERS OF THE
COLONY POSSESSED GENETICALLY CODED R (RESISTANCE) FACTORS, CONFERRING THE
ABILITY TO WITHSTAND SUCH CHEMICAL ASSAULTS.

THE LEDERBERGS DISCOVERED TESTS
THAT COULD IDENTIFY STREPTOMYCIN-RESISTANT ESCHERICHIA COLI INTESTINAL BACTERIA
BEFORE THE ORGANISMS WERE EXPOSED TO ANTIBIOTICS. THEY ALSO SHOWED THAT
THE USE OF ANTIBIOTICS IN COLONIES OF BACTERIA IN WHICH EVEN LESS THAN 1 PERCENT
OF THE ORGANISMS WERE GENETICALLY RESISTANT COULD HAVE TRAGIC RESULTS. THE
ANTIBIOTICS WOULD KILL OFF 99 PERCENT OF THE BACTERIA THAT WERE SUSCEPTIBLE,
LEAVING A VAST NUTRIENT-FILLED PETRI DISH FREE OF COMPETITORS FOR THE SURVIVING
RESISTANT BACTERIA. LIKE WEEDS THAT SUDDENLY INVADED AN UNTENDED OPEN
FIELD, THE RESISTANT BACTERIA RAPIDLY MULTIPLIED AND SPREAD OUT, FILLING THE
PETRI DISH WITHIN A MATTER OF DAYS WITH A UNIFORMLY ANTIBIOTIC-RESISTANT
POPULATION OF BACTERIA.

CLINICALLY THIS MEANT THAT THE
WISE PHYSICIAN SHOULD HIT AN INFECTED PATIENT HARD, WITH VERY HIGH DOSES OF
ANTIBIOTICS THAT WOULD ALMOST IMMEDIATELY KILL THE ENTIRE SUSCEPTIBLE
POPULATION, LEAVING THE IMMUNE SYSTEM WITH THE RELATIVELY MINOR TASK OF WIPING
OUT THE REMAINING RESISTANT BACTERIA. FOR PARTICULARLY DANGEROUS
INFECTIONS, IT SEEMED ADVISABLE TO INITIALLY USE TWO OR THREE DIFFERENT TYPES OF
ANTIBIOTICS, ON THE THEORY THAT EVEN IF SOME BACTERIA HAD R FACTORS FOR ONE TYPE
OF ANTIBIOTIC, IT WAS UNLIKELY A BACTERIUM WOULD HAVE R FACTORS FOR SEVERAL
WIDELY DIVERGENT ANTIBIOTICS.

NOTE: THE PARAGRAPH ABOVE
BASICALLY FINISHES THE DISCUSSION OF BACTERIAL RESISTANCE. HOWEVER, THIS EXCERPT FROM LAURIE GARRETT'S BOOK
CONTINUES BECAUSE TICKS CAN CARRY VARIOUS MICROBES AND IT IS
GENERALLY KNOWN THAT LYME/BABESIA CAN BE A PARTICULARLY DIFFICULT COMBINATION TO
CONQUER.

TO CONTINUE, THEN:

IF MANY YOUNG SCIENTISTS OF THE
MID-1960S CONSIDERED BACTERIOLOGY PASSÉ - A FIELD COMMONLY REFERRED TO AS
"A SCIENCE IN WHICH ALL THE BIG QUESTIONS HAVE BEEN ANSWERED" - THE
STUDY OF PARASITOLOGY WAS THOUGHT TO BE POSITIVELY PREHISTORIC.

PARASITE, PROPERLY DEFINED, IS
"ONE WHO EATS BESIDE OR AT THE TABLE OF ANOTHER, A TOADY; IN BIOLOGY, A
PLANT OR ANIMAL THAT LIVES ON OR IN ANOTHER ORGANISM, FROM WHICH IT DERIVES
SUSTENANCE OR PROTECTION WITHOUT MAKING COMPENSATION." (15) STRICTLY
SPEAKING, THEN, ALL INFECTIOUS MICROBES COULD BE LABELED PARASITES, FROM VIRUSES
TO RINGWORMS.

BUT HISTORICALLY, THE SCIENCES OF
VIROLOGY, BACTERIOLOGY, AND PARASITOLOGY HAVE EVOLVED QUITE SEPARATELY, WHICH
FEW SCIENTISTS - OTHER THAN "DISEASE COWBOYS" LIKE JOHNSON AND
MACKENZIE - TRAINED OR EVEN INTERESTED IN BRIDGING THE DISCIPLINES. BY THE
TIME HEMORRHAGIC FEVER BROKE OUT IN BOLIVIA, THE VERY ARTIFICIAL SET OF
DISTINCTIONS HAD DEVELOPED BETWEEN THE FIELDS. PLAINLY PUT, LARGER
MICROBES WERE CONSIDERED PARASITES: PROTOZOA, AMOEBAE, WORMS. THESE WERE
THE DOMAIN OF PARASITOLOGISTS.

THEIR SCIENTIFIC REALM HAD BEEN
ABSORBED BY ANOTHER, EQUALLY ARTIFICIALLY DESIGNATED FIELD DUBBED TROPICAL
MEDICINE, WHICH OFTEN HAD NOTHING TO DO WITH EITHER GEOGRAPHICALLY TROPICAL
AREAS OR MEDICINE.

BOTH DISTINCTIONS - PARASITOLOGY
AND TROPICAL MEDICINE - SET OFF THE STUDY OF DISEASES THAT LARGELY PLAGUED THE
POORER, LESS DEVELOPED COUNTRIES OF THE WORLD FROM THOSE THAT CONTINUED TO
TROUBLE THE INDUSTRIALIZED WORLD. THE FIELD OF TROPICAL MEDICINE DID SO
MOST BLATANTLY, ENCOMPASSING NOT ONLY CLASSICALLY DEFINED PARASITIC DISEASES BUT
ALSO VIRUSES (E. G., YELLOW FEVER AND THE VARIOUS HEMORRHAGIC FEVER VIRUSES) AND
BACTERIA (E.G., PLAGUE, YAWS, AND TYPHUS) THAT WERE BY THE MID-TWENTIETH CENTURY
EXTREMELY RARE IN DEVELOPED COUNTRIES.

IN THE EIGHTEENTH CENTURY THE
ONLY ORGANISMS BIG ENOUGH TO BE STUDIED EASILY WITHOUT THE AID OF POWERFUL
MICROSCOPES WERE THE LARGER PARASITES THAT INFECTED HUMAN BEINGS IN SOME STAGE
OF THE OVERALL LIFE OF THE CREATURE. DOCTORS COULD, WITHOUT MAGNIFICATION,
SEE RINGWORMS OR THE EGGS OF SOME PARASITES IN PATIENTS' STOOLS. WITHOUT
MUCH MAGNIFICATION (ON THE ORDER OF HUNDREDS-FOLD VERSUS THE THOUSANDS-FOLD
NECESSARY TO STUDY BACTERIA) SCIENTISTS COULD SEE THE DANGEROUS FUNGAL COLONIES
OF CANDIDA ALBACANS GROWING IN A WOMAN'S VAGINA, SCABIES ASCARIASIS ROUNDWORMS
IN AN UNFORTUNATE VICTIM'S SKIN, OR CYSTISERCOSIS TAPEWORMS IN THE STOOLS OF
INDIVIDUALS FED UNDERCOOKED PORK.

AS BRITISH AND FRENCH IMPERIAL
DESIGNS INCREASINGLY IN THE LATE EIGHTEENTH CENTURY TURNED TO COLONIZATION OF
AREAS SUCH AS THE INDIAN SUBCONTINENT, AFRICA, AND SOUTHEAST ASIA, TROPICAL
MEDICINE BECAME A DISTINCT AND POWERFUL SCIENCE THAT SEPARATED ITSELF FROM WHAT
WAS CONSIDERED A MORE PRIMITIVE FIELD, BACTERIOLOGY. SCIENTIST HISTORIAN
JOHN FARLEY CONCLUDED THAT WHAT BEGAN AS A SEPARATION DESIGNED TO LEND
PARASITOLOGY GREATER RESOURCES AND ESTEEM - AND DID SO IN THE EARLY NINETEENTH
CENTURY - ENDED UP LEAVING IT SCIENCE'S STEPCHILD. (16)

IRONICALLY, PARASITES,
CLASSICALLY DEFINED, WERE FAR MORE COMPLEX THAN BACTERIA AND THEIR STUDY
REQUIRED A BROADER RANGE OF EXPERTISE THAN WAS EXACTED BY TYPICAL E. COLI
BIOLOGY. TOP PARASITOLOGISTS - OR TROPICAL MEDICINE SPECIALISTS, IF YOU
WILL - WERE EXPECTED IN THE MID-1960S TO HAVE VAST KNOWLEDGE OF TROPICAL
INSECTS, THE DISEASE-CARRYING ANIMALS, THE COMPLICATED LIFE CYCLES OF OVER A
HUNDRED DIFFERENT RECOGNIZED PARASITES, HUMAN CLINICAL RESPONSES TO THE
DISEASES, AND THE WAYS IN WHICH ALL THESE FACTORS INTERACTED IN PARTICULAR
SETTINGS TO PRODUCE EPIDEMICS OR LONG PERIODS OF ENDEMIC, OR PERMANENT, DISEASE.

CONSIDER THE EXAMPLE OF ONE OF
THE WORLD'S MOST UBIQUITOUS AND COMPLICATED DISEASES: MALARIA. TO TRULY
UNDERSTAND AND CONTROL THE DISEASE, SCIENTISTS IN THE MID-TWENTIETH CENTURY WERE
SUPPOSED TO HAVE DETAILED KNOWLEDGE OF THE COMPLEX LIFE CYCLE OF THE MALARIAL
PARASITE, THE INSECT THAT CARRIED IT, THE ECOLOGY OF THAT INSECT'S HIGHLY
DIVERSE ENVIRONMENT, OTHER ANIMALS THAT COULD BE INFECTED WITH THE PARASITE, AND
HOW ALL THESE FACTORS WERE AFFECTED BY SUCH THINGS AS HEAVY RAINFALL, HUMAN
MIGRATIONS, CHANGES IN MONKEY* POPULATIONS, AND THE LIKE.

IT WAS KNOWN THAT SEVERAL
DIFFERENT STRAINS OF ANOPHELES MOSQUITOES COULD CARRY THE TINY PARASITES.
THE FEMALE ANOPHELES WOULD SUCK PARASITES OUT OF THE BLOOD OF INFECTED HUMANS OR
ANIMALS WHEN SHE INJECTED HER SYRINGE-LIKE PROBOSCIS INTO THE SURFACE CAPILLARY
TO FEED. THE MICROSCOPIC MALE AND FEMALE SEXUAL STAGES OF THE PARASITES,
CALLED GAMETOCYTES, WOULD MAKE THEIR WAY UP THE PROBOSCIS AND INTO THE FEMALE
MOSQUITO'S GUT, WHERE THEY WOULD UNITE SEXUALLY AND MAKE A TINY SAC IN THE
LINING OF THE INSECT'S STOMACH.

OVER A PERIOD OF ONE TO THREE
WEEKS THE SAC WOULD GROW, AS INSIDE THOUSANDS OF SPOROZOITE-STAGE PARASITES ARE
MANUFACTURED. EVENTUALLY, THE SAC WOULD EXPLODE, FLOODING THE INSECT'S GUT
WITH MICROSCOPIC ONE-CELLED PARASITES THAT CAUSED TO THE COLD-BLOODED INSECT;
THEIR TARGET WAS A WARM-BLOODED CREATURE, ONE FULL OF RED BLOOD CELLS.

SOME OF THE SPOROZOITES WOULD
MAKE THEIR WAY INTO THE INSECT'S SALIVARY GLANDS, FROM WHICH THEY WOULD BE DRAWN
UP INTO THE "SYRINGE" WHEN THE MOSQUITO WENT ON HER NIGHTLY SUNDOWN
FEEDING FRENZY, AND BE INJECTED INTO THE BLOODSTREAM OF AN UNFORTUNATE HUMAN
HOST.

AT THAT POINT THE SPEED AND
SEVERITY OF EVENTS (FROM THE HUMAN HOST'S PERSPECTIVE) WOULD DEPEND ON WHICH OF
THE FOUR KEY MALARIAL SPECIES HAD BEEN INJECTED BY THE MOSQUITO. A GOOD
PARASITOLOGIST IN THE 1950S KNEW A GREAT DEAL ABOUT THE DIFFERENCES BETWEEN THE
FOUR SPECIES, TWO OF WHICH WERE PARTICULARLY DANGEROUS: PLASMODIUM VIVAX AND P.
FALCIPARUM.

IF A HUMAN HOST WAS MOST UNLUCKY,
THE PARASITES COURSING THROUGH HER BLOODSTREAM WOULD BE P. FALCIPARUM AND SHE
WOULD HAVE ONLY TWELVE DAYS TO REALIZE SHE'D BEEN INFECTED AND GET TREATMENT OF
SOME KIND BEFORE THE DISEASE WOULD STRIKE, IN THE FORM OF EITHER ACUTE ANEMIA OR
SEARING INFECTION OF THE BRAIN.

IN EITHER CASE, FOR AN INDIVIDUAL
WHOSE IMMUNE SYSTEM HAD NEVER BEFORE SEEN P. FALCIPARUM, THE OUTCOME WOULD
LIKELY BE DEATH. . . . . .

. . . .
ALMOST
ENTIRELY ABSENT IN THE MID-TWENTIETH CENTURY WAS AN INTELLECTUAL PERSPECTIVE
THAT WEDDED THE ECOLOGICAL OUTLOOK OF THE CLASSICAL PARASITOLOGIST WITH THE
BURGEONING NEW SCIENCE OF MOLECULAR BIOLOGY THEN DOMINATING THE STUDY OF
NONTROPICAL BACTERIA AND VIRUSES. MONEY WAS SHIFTING AWAY FROM RESEARCH ON
DISEASES LIKE MALARIA AND SCHISTOSOMIASIS. YOUNG SCIENTISTS WERE
ENCOURAGED TO THINK AT THE MOLECULAR LEVEL, CONCENTRATING ON DNA AND THE MANY
WAYS IT AFFECTED CELLS."